Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 769 | PR |
NPI | 1033264676 |
---|---|
Provider Name | Dr. Enrique Amy |
First Address | Ponce, PR 00717-1548 |
Second Address | Ponce, PR 00717-1548 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 08/07/2007 |